Shoulder Arthroscopy

Overview

After knee arthroscopy, shoulder arthroscopy is the second most common orthopedic surgery. Orthopedic surgery focuses on the treatment of joints, bones, muscles, ligaments, and tendons. One of the most prevalent types of shoulder arthroscopy is rotator cuff surgery.

Shoulder arthroscopy is a minimally invasive surgery used to detect and treat issues with the shoulder. Arthroscopy may be required if you have rotator cuff injuries or shoulder impingement. Minimally invasive surgery necessitates smaller incisions than regular surgery. Every incision is roughly the size of a keyhole.

Shoulder arthroscopy assists physicians in locating and treating shoulder discomfort that has not responded to conventional therapies. Physical therapy, medication, injections, and rest are among nonsurgical therapies for shoulder discomfort.

Through a small incision in your skin, the surgeon inserts a small camera called an arthroscope. This camera records images of your shoulder joint and displays them on a video screen. These photos are examined by your provider in order to determine the cause of your injury. If you require a shoulder repair, the provider will utilize microscopic surgical instruments to restore the mobility of your shoulder.

Shoulder arthroscopy is generally very safe. There is a small risk that you may experience: Blood clots, Damage to blood vessels or nerves, Excessive bleeding or swelling, and Infection.

What does your shoulder consist of?

Your shoulder is a complex joint that is capable of more motion than any other joint in your body. It is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).

• Ball and socket: The head of your upper arm bone fits into a rounded socket in your shoulder blade. This socket is called the glenoid. A slippery tissue called articular cartilage covers the surface of the ball and the socket. It creates a smooth, frictionless surface that helps the bones glide easily across each other. The glenoid is ringed by strong fibrous cartilage called the labrum. The labrum forms a gasket around the socket, adds stability, and cushions the joint.
• Shoulder capsule: The joint is surrounded by bands of tissue called ligaments. They form a capsule that holds the joint together. The undersurface of the capsule is lined by a thin membrane called the synovium. It produces synovial fluid that lubricates the shoulder joint.
• Rotator cuff: Four tendons surround the shoulder capsule and help keep your arm bone centered in your shoulder socket. This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus and attaches it to your shoulder blade.
• Bursa: There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa helps the rotator cuff tendons glide smoothly when you move your arm.

What shoulder injuries does Arthroscopic Shoulder Surgery treat?

Your doctor may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation and allow injured tissues to heal. Inflammation is one of your body's normal reactions to injury or disease. In an injured or diseased shoulder joint, inflammation causes swelling, pain, and stiffness.

Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.

Common arthroscopic procedures include:

1. Rotator cuff repair:

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder. A rotator cuff injury can cause a dull ache in the shoulder, which often worsens with use of the arm away from the body.

Rotator cuff injuries are common and increase with age. These may occur earlier in people who have jobs that require repeatedly performing overhead motions. Examples include painters and carpenters.Many people with rotator cuff disease can manage their symptoms and return to activities with physical therapy exercises that improve flexibility and strength of the muscles surrounding the shoulder joint.

Sometimes, rotator cuff tears may occur as a result of a single injury. In those circumstances, medical evaluation should be provided as soon as possible to discuss the role of surgery. Extensive rotator cuff tears may not be fixable, and transfer of alternative tendons or joint replacement may be possible.

2. Removal or repair of the labrum:

Labral repair surgery is a procedure used to reverse damage to the labrum, or cartilage, in the shoulder. The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade, called the glenoid. A soft fibrocartilaginous tissue rim, labrum surrounds the socket like a form of “weather stripping” and deepens it by up to 50 percent so that the head of the upper arm bone fits more securely and moves easily within the socket. If the labrum is torn, it can greatly hinder movement in the shoulder while causing a tremendous amount of pain.

The labrum can be torn due to a sports injury to the shoulder and often occurs in people who participate in football, baseball, golf, weightlifting, and tennis or who suffer traumatic injuries such as falls or motor vehicle accidents. A labral tear also can be caused by the aging process that makes the labrum brittle and more susceptible to tears. When you have a labral tear, your shoulder becomes stiff and painful and tends to catch during movement. Activity will be limited and painful to accomplish. Labral repair surgery can regain motion in the shoulder and ease the painful symptoms.

Treatment for labral repair depends on the type of tear that has occurred in the shoulder. Most labral tears can be treated with nonsurgical methods, but when painful symptoms persist despite treatment, labral repair surgery could be necessary.

3. Repair of ligaments:

Due to the complex structure of the shoulder, ligaments and tendons within the shoulder are more susceptible to injury. The shoulder structure is made of three major joints: glenohumeral joint, the acromioclavicular joint, and the sternoclavicular joint. These three structures require several crucial ligaments and tendons to maintain the shoulder’s range of motion and stability. The unique structure of the shoulder is less stable than other joints and, as such is prone to dislocation and particularly susceptible to osteoarthritis.

Damage to tendons and ligaments causes severe pain and a loss of range of motion. When ligaments and tendons tear or detach, it weakens the already fragile structure of the shoulder and, if left unattended, can cause severe, long-term injuries.

Typically, surgery will involve anchoring newly sutured tendons or ligaments to bones to allow them to heal and naturally reattach.

4. Removal of inflamed tissue or loose cartilage:

Arthroscopic shoulder surgery can be used to remove any inflamed tissue or damaged lining of the shoulder joint and any loose tissue in the shoulder.

5. Repair for recurrent shoulder dislocation:

If you have a history of shoulder dislocations or your shoulder just feels “loose,” you may have instability of the shoulder. Shoulder arthroscopy can tighten the structures in your shoulder, create stability and prevent further dislocations.

6. Acromio-Clavicular joint resection:

Shoulder arthroscopy also can be used for arthritic conditions of the shoulder. A common place to find arthritis is at the acromio-clavicular joint that connects your collar bone (clavicle) to your shoulder. The arthritis can be removed via this minimally invasive technique to relieve your pain.

7. Impingement/bone spur removal:

A spur is a growth on a bone that can damage and impinge on surrounding bones, ligaments, and tendons such as the rotator cuff. Bone spurs usually form in response to pressure, irritation, inflammation and/or stress on the bone for a long period of time. They also can form because of arthritis. A bone spur is a result of the body trying to repair itself by building extra bone. Using minimally invasive shoulder arthroscopy, your surgeon can go directly to the bone spur and remove it.

Less common procedures such as nerve release, fracture repair, and cyst excision can also be performed using an arthroscope. Some surgical procedures, such as shoulder replacement, still require open surgery with more extensive incisions.

What happens before Arthroscopic Shoulder Surgery?

Before shoulder arthroscopy, your provider will ask you about your health history. You’ll also need to bring in a complete medication list. You may need to stop taking some of your medications a few days before your surgery.

Your hospital will give you specific instructions, including how long before your surgery to stop eating and drinking.

To check your health before your procedure, you also may need:

• Blood tests.
• A chest X-ray.
• Electrocardiogram

What happens during Shoulder Arthroscopy?

Shoulder arthroscopy usually takes less than an hour. During shoulder arthroscopy:

1. You will be in a semi-seated position (beach chair position) or lying on your side.
2. Your surgical team will shave hair (if needed) and clean your skin with an antiseptic solution. They may place your arm in a holding device to make sure it stays still.
3. A healthcare provider may inject fluid into your shoulder. The fluid inflates your shoulder joint, making it easier for the surgeon to see.
4. Your surgeon makes a small hole, usually about the size of a buttonhole, in your shoulder. They insert the tiny camera (arthroscope) into this incision.
5. The camera projects images of your shoulder to a video screen. Your surgeon uses these images to find the problem with your shoulder.
6. Your surgeon makes other small cuts in your shoulder and inserts tiny instruments.
7. Once your surgical team finishes your surgery, they close the incisions. You may have stitches or small bandages, with a large bandage on top.

How painful is Shoulder Arthroscopy?

Unfortunately, all surgery is extremely painful. Your hospital's anesthetic staff, on the other hand, is focused with keeping you comfortable throughout operation. They will discuss your options with you.

Nerve blocks are routinely delivered into your neck or shoulder during shoulder arthroscopy surgery. Numbness in your shoulder and arm is caused by these nerve blocks. They also help with pain control after surgery. You may be given general anesthetic in some cases, which will put you to sleep during your procedure.

Pain is a normal aspect of the healing process. Discuss your concerns with your healthcare providers. They can give you advice on how to deal with pain as your body heals.

What are the advantages of Arthroscopic Shoulder Surgery?

Some of the benefits of arthroscopic surgery over traditional open surgery include:

1. Can usually be carried out as an outpatient procedure.
2. Swelling is substantially reduced due to minimal incisions.
3. Pain is substantially reduced due to minimal manipulation of healthy tissue.
4. Risk of infection is less due to the minimally invasive approach.
5. Risk of complications associated with blood loss is notably minimal.
6. Shorter hospital stay and much lesser recovery time.
7. Very minimal incisional scarring.
8. Reduced surgical risk as arthroscopic surgery is a minimally invasive procedure.
9. Usually more successful than open joint procedures.
10. Both diagnosis and surgery can be carried out in one approach.
11. Use of tiny instruments in arthroscopy aids in minimal damage to surrounding tissues compared to large-sized surgical devices.

What are the risks or complications of Shoulder Arthroscopy?

The risks and complications of an arthroscopic procedure are minimal and occur in less than one percent of all arthroscopic surgeries. Some of the possible risks and complications of arthroscopic surgery include:

• Swelling or bleeding.
• Blood clots.
• Damage to nerves or blood vessels.
• Instrument breakage.
• Anesthetic problems.

What Should you do after surgery?

After surgery, you will stay in the recovery room for 1 to 2 hours before being discharged home. Nurses will monitor your responsiveness and provide pain medication, if needed. You will need someone to drive you home and stay with you for at least the first night.

• At Home:

Although arthroscopy recovery is frequently faster than open surgical recovery, it may still take weeks to months for your shoulder joint to fully recover.

For several weeks following surgery, you should expect some pain and discomfort. However, if you have had a more thorough operation, it may take longer for your pain to decrease. Pain and swelling can be reduced by applying ice to the affected area. If necessary, your doctor may prescribe pain medication.

To help reduce pain, a variety of pain medications are available, including opioids, nonsteroidal anti-inflammatory medicines (NSAIDs), and local anesthetics. Medication for pain can help you feel more comfortable, which will help your body heal and recover from surgery faster.

Opioids can give effective pain relief, but they are a narcotic and can be addicted. It is critical to utilize opioids only as prescribed by your doctor. As soon as your pain begins to subside, you should discontinue use of these medications.

Although it has no effect on how your shoulder recovers, lying flat may create discomfort by pulling on your shoulder. During the first few days after surgery, some patients prefer to sleep in a reclining chair or propped up in bed.

You should be able to replace your huge bandage with simple Band-Aids a few days after surgery. You may shower once your wounds have stopped flowing, but avoid soaking or scrubbing your incisions. To safeguard your shoulder, you will most likely need to use a sling or a specific immobilizer. Your surgeon will discuss how long the sling will be required with you.

• Rehabilitation:

Rehabilitation is critical in getting you back to your everyday routines. Exercise will assist you in regaining shoulder strength and motion. Based on the surgical operations you required, your surgeon will create a rehabilitation plan for you.

If you have a more sophisticated surgical repair, your surgeon may recommend that you work with a physical therapist to oversee your exercise routine. It is critical that you make a real effort at rehabilitation in order for your surgery to be successful.

Conclusion

Shoulder arthroscopy, commonly known as "a shoulder scope," is a minimally invasive surgical procedure used by orthopedic surgeons to treat rotator cuff tendon tears, cartilage abnormalities, shoulder instability, torn ligaments, and bone spurs. An arthroscope is a pencil-thin equipment that has a system of lenses, a light, and a small video camera that allows your surgeon to view into your shoulder joint.

Since the late 1980s, orthopedic surgeons have been performing arthroscopic surgery on a wide range of painful shoulder disorders. Shoulder arthroscopy, according to the American Academy of Orthopaedic Surgeons (AAOS), has made diagnosis, treatment, and recuperation from surgery easier and faster than was previously considered possible. Every year, new instruments and techniques are created to improve the surgical process even further.

In comparison to open procedures, arthroscopic surgeries offer a lower infection risk and a shorter recovery period. Shoulder arthroscopy is also less prone to causing joint stiffness and pain than open surgery. Shoulder arthroscopy is generally considered to be quite safe. There is a slight chance that you will develop blood clots, damage to blood vessels or nerves, excessive bleeding or swelling, or infection.

After shoulder arthroscopy, your shoulder joint will take weeks to months to heal entirely. For at least a few weeks, you may have pain and edema. Pain treatment can be achieved by the use of ice and pain medicines. For a few days after your operation, you can also try sleeping raised up in a chair or bed. To safeguard your shoulder, your surgeon may advise you to wear a sling.

A rehabilitation plan includes gentle exercise and physical therapy. It can increase your shoulder movement and strength. Your healthcare provider will give you a rehab plan that suits your specific shoulder surgery.